Diagnostic And Therapeutic Strategies Of Prolactinomas

ObjectiveTo achieve the standardized and individual strategies to diagnose and therapy prolactinoma. MethodsRespectively study the clinical data and therapeutic effect of thirty-seven prolactinomas from May, 1996 to Nov, 2004. Results19 patients had received medical therapy of bromocriptine. All the patients presented serum PRL level declining and tumor-volume reducing except four. But all the 19 patients required surgical treatment because of the intolerable side-effects or inacceptable long-life medical treatment. Surgical therapy was done on all the group patients. 21 operations were performed by intracranial route and another 16 were by transsphenoidalroute. Total removal under microscope was performed on 27 patients (73%) and 10 were inadequate (3 by transsphenoidal, 7 by intracranial). Side-effects were always seen after intracanial surgery. Postoperative PRL examination and MRI were done in all patients. Ten had remnants and adjuvant medical treatment was performed on all the ten patients. Eight of them received radiosurgical treatment. Postoperation follow-up was 8 months to 89 months. The mean is 34 months. 4 patients recurred and one of them received second surgery, another 3 performed radiosurgery. ConclusionsThe diagnose of prolactinomas depend on clinical characters, serum PRL level and sella MRI. Dopamme receptor agonist may be the primary treatment for partial patients. If the patients are non-responders or intolerant to side-effects, or can't accept a long-life medical therapy, or have optical deficient, then surgical treatment must be mentioned. And the first-choice of surgical approach is transsphenoidal route. Radiosurgery is restricted to remnants and recurrent prolatinomas. We must use standardized and individual treatment to improve the results of therapy to prolacinomas.